Shoulder pain during push-ups is a common issue indicating a specific biomechanical problem within the shoulder joint. The shoulder is a highly mobile ball-and-socket structure, relying heavily on surrounding soft tissues for stability. When performing a push-up, you place immense compressive forces on this joint, requiring precise muscular coordination to keep the arm bone centered in the socket. Pain during this movement suggests that this stabilization mechanism is failing, causing underlying irritation or injury. This type of pain is not a sign of weakness but rather an indication that the mechanics of the movement are placing undue stress on sensitive structures.
Why Push-Ups Specifically Cause Shoulder Pain
The primary cause of shoulder pain during push-ups is often a reduction in the subacromial space beneath the bony roof of the shoulder. This space houses the rotator cuff tendons and the bursa. When compressed, it leads to shoulder impingement. Improper push-up technique directly contributes to this compression by placing the shoulder in a mechanically disadvantageous position.
The most frequent form flaw is allowing the elbows to flare out to the sides, moving toward a 90-degree angle from the torso. This wide hand position internally rotates the arm bone, pinching soft tissues, including the supraspinatus tendon, against the acromion bone. Maintaining the elbows tucked closer to the body, ideally at a 45-to-60-degree angle, helps preserve the necessary space for the tendons.
Another significant factor is poor control of the scapula (shoulder blade). The push-up requires the shoulder blade to move smoothly and stabilize the joint, particularly through the serratus anterior muscle. If the shoulder blades “shrug” or wing out, joint stability is compromised. This forces the smaller rotator cuff muscles, which are dynamic stabilizers, to act as primary movers. This overuse can lead to rotator cuff tendinopathy, where the tendons become strained or irritated. The resulting pain is a signal that the larger, stabilizing muscles are not performing their role effectively, making the rotator cuff the victim of poor form.
Immediate Self-Care and Movement Adjustments
The first self-care step is to immediately stop performing any exercise that reproduces the pain. Continuing through the discomfort will only aggravate the underlying tissue irritation and delay healing. Apply ice to the painful area on the front or top of the shoulder for 10 to 15 minutes several times a day to reduce inflammation.
Resting the joint does not mean complete immobility; gentle, pain-free range of motion is important for recovery. A good starting point is the pendulum exercise. Lean over and let the affected arm hang down, gently swinging it in small circles or front-to-back, using gravity rather than muscle contraction. This passive movement helps to decompress the joint without stressing the irritated tendons.
For temporary alternatives to maintain strength, modify the movement to a pain-free range. Performing push-ups against a wall or using an elevated surface significantly reduces the load on the shoulder joint. If these variations are entirely pain-free, they can serve as a bridge until you address the underlying mechanics.
Safe Progression Back to Strength Training
A safe return to strength training focuses on correcting flawed movement patterns and rebuilding the supporting muscle system around the shoulder blade. Begin by mastering the correct push-up form, which involves tucking the elbows toward the ribs and maintaining a straight line from head to heels by bracing the core and glutes. This position encourages better recruitment of the chest and triceps while protecting the shoulder capsule.
Start your training progression with the least challenging variation, such as wall push-ups. Gradually move to incline push-ups, then kneeling push-ups, and finally to the standard floor push-up, ensuring each step is completely pain-free before advancing. Simultaneously, integrate specific rehabilitative exercises to strengthen the muscles responsible for shoulder stability. Scapular stability work, such as prone “T” and “Y” exercises, helps train the muscles between the shoulder blades to hold the joint in a better position.
Focus on the external rotation muscles, namely the infraspinatus and teres minor, which are crucial for centering the arm bone in the socket. Exercises like side-lying external rotations with light weight or banded external rotations performed with the elbow tucked to the side can strengthen these dynamic stabilizers. Consistent work on these muscles and form correction is necessary to prevent the recurrence of push-up related shoulder pain.
Warning Signs That Require Medical Consultation
While most mild shoulder pain improves with rest and movement adjustments, certain symptoms indicate a more severe injury requiring medical assessment. Seek consultation if the pain is severe and sudden, especially if it followed a popping or tearing sensation in the joint. Pain that persists constantly, even while the arm is at rest or during the night, warrants an evaluation by a physical therapist or physician.
Other red flags include an inability to lift the arm, a noticeable loss of strength, or a visible deformity or swelling around the shoulder joint. Pain that radiates down the arm into the hand, accompanied by numbness or tingling, suggests potential nerve involvement, such as a cervical spine issue or nerve compression. Self-management is only appropriate for mild symptoms that begin to resolve within a few days.